Testing for ovarian reserve with Anti Mullerian Hormone (AMH)
You may have heard about a “new” test for telling you if you’re “too old” to get pregnant or that you will get pregnant easily despite being “older”. Well, that’s not exactly what this test does but it can provide useful information about fertility . It’s a blood test that looks for a protein named Anti Mullerian Hormone or AMH. It is a protein produced by the ovaries. This level can be checked to give an estimate of “ovarian reserve” i.e. your egg supply. We know that egg supply decreases over time and can be a factor in why “older” women (age 35 and after – sorry ladies!) may have more trouble getting pregnant. A female baby has 1-2 million eggs. This number is down to 300,000 – 500,000 at puberty and down to 25,000 at age 37. This is one reason that fertility (or the ease with which a woman can get pregnant without medical help) decreases as women age. AMH levels decrease down to undetectable at menopause due to severely declining egg supply.
AMH levels can be reported in a couple different ways. When reported as ng/ml, a value less than 2.2, or some use a value less than 1, is concerning for decreased ovarian reserve.
In women age 30-44, a higher level of AMH has a positive correlation with natural fertility. For women needing In Vitro Fertilization (IVF), a higher level of AMH is known to be useful in predicting success of having a baby. This is because higher AMH levels mean the ovarian follicles respond better to drugs, or there are more follicles to respond, therefore leading to more eggs retrieved, and higher chance of pregnancy. Very high levels of AMH can also predict those that will have too much response to fertility drugs, a condition called hyperstimulation or may be suggestive of (but not diagnostic for) a condition like Polycystic Ovarian Syndrome (PCOS). In women under age 35, low AMH levels didn’t predict low IVF success rates.
There are some things to keep in mind about AMH testing. AMH doesn’t tell us about egg quality, only quantity. We know miscarriage rates increase as women age sometimes due to poor egg quality and a good AMH level wouldn’t decrease this miscarriage chance. Also, a women’s advancing age is always a negative factor for successful fertility regardless of AMH levels; i.e. a great AMH level doesn’t take away from a woman’s age related fertility concerns.
There are other factors, besides age, that can decrease ovarian reserve: smoking, strong family history of very early menopause, history of surgery on an ovary, history of chemotherapy or pelvic radiation, severe endometriosis , and a history of pelvic infections.
If you are 35 or older and have been trying to get pregnant for 6 months or more without success, you should be seen in our office to discuss this and other testing as well as treatment to help you conceive. If you are 40 or older and are trying or would like to try to get pregnant, you should also see us for an office consultation.
JAH 10/16 AW